1. Do children with cleft palate have expressive and receptive language impairment? The NSW Cleft Palate EBP Group

2. Jana Carr Sharyn Greig Melissa Parkin Amanda Simon Alison Purcell*

3. Background Information – Cleft Lip and Palate

4. Incidence Internationally –0.4 – 2.2 per 1000 live births Australia –1 per 700 live births

5. Treatment Challenges Feeding Surgical repair Hearing loss Communication disorders Dental development Psychosocial problems

6. Communication disorders Speech –Articulation –Phonology

7. Resonance –Hypernasality –Hyponasality –Mixed resonance

8. Phonation Soft Hoarse Dysphonic

9. Other CLP phenotypic features –Asymmetry –Non-right handedness –Craniofacial morphology –Dental anomalies –Obicularis oris muscle defects –Structural brain and vertebral anomalies –Minor physical anomalies –Velopharyngeal dysfunction

10. Family Traits Unaffected relatives –Facial morphology differs from controls Increased facial width –Dentition differs

11. CLP Phenotype Language Learning Reading Cognition Social skills

12. Nation (1970) “Cleftness” syndrome

13. Clinical question Do children with cleft lip and palate have a higher incidence of expressive and expressive language impairment compared to children without cleft palate?

14. Search of the evidence Cleft palate EBP members Hearing and Speech students –Selection Criteria The last 10 years Any type of cleft but no additional syndrome Language and learning Not pre-linguistic language

15. Information sources Cochrane library Medline CIAP OVID

16. Evidence reviewed AuthorsYearNumber of Participants Age of Participants 1. Kapp-Simon & McGuire 19971312 - 14 yrs 2. Chapman et al.1998203.7 - 4.9 yrs 7.6 - 9.6 yrs 3. Schonweiler & Lisson 19993704.5 yrs 5 - 10 yrs 4. Pamplona et al.2000583 - 8 yrs 5. Morris & Ozanne2003202 and 3 yrs 6. Synder & Synder2004201.5 – 2.5 yrs 7. Frederickson et al. 2006172.9 - 3.8 yrs

17. Strength of the evidence Number of Studies Level of Evidence

18. Speech Pathology Practice Guidelines – (Clinic bottom line) Limited evidence that children with CP have increased receptive and expressive language impairment

19. Risk factors On-going hearing loss Co-occurring articulation impairment Low socio-economic status

20. Speech Pathology Practice Guidelines Specialist Cleft Palate Clinics –Cross centre annual language assessments 12 months 24 months 3 years 4 years etc

21. Speech Pathology Practice Guidelines Community Speech Pathology Clinics –Monitor language development –Parent language enrichment and education –School readiness programs –Monitor later language development –Monitor academic achievement

22. Speech Pathology Practice Guidelines Further research to expand the phenotype –Language development –Family history of language impairment –Genetics

23. Thank You!